Multi-path electronic prescription processing system

ABSTRACT

An electronic prescription processing system which is capable of direct two-way electronic communication between the physician and the pharmacist, in one example, uses a multi-path clearinghouse between the physician&#39;s office practice management system and a pharmacy computer system. In one example, the multi path electronic prescription processing system allows a physician to create electronic prescriptions using an electronic signature, and using the multi-path clearinghouse, allow for interface with the pharmacy computer system such that an image of an electronic prescription and prescription information are directly auto-populated into an entry screen of the pharmacy computer system.

REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/337,422 filed Dec. 17, 2008 which claims the benefit of ProvisionalPatent Application No. 61/014,218 filed Dec. 17, 2007, the disclosuresof which are hereby incorporated herein by reference.

FIELD OF THE INVENTION

The field relates to electronic prescription systems.

BACKGROUND

Currently, many pharmacists or technicians contact the physiciandirectly through telephone or facsimile, if they have questions with aparticular prescription but such a process is time consuming and can beexpensive.

U.S. Pat. No. 5,883,370, describes how the physician writes aprescription by entering the prescription into a computer which printsout a bar-coded prescription that may be taken by the patient to thepharmacy, or a future modem path, which would enable the physician tosend the prescription directly to a particular pharmacy computer.However, the pharmacist would have to scan the bar code on theprescription and manually enter the prescription into the pharmacycomputer or scan the prescription slip bar code into the pharmacycomputer directly and the system described is only a one-way system,from the physician to the pharmacist, as disclosed in col. 5, lns.16-27. Prior art systems, such as the one described in this reference,do not provide for seamless, automated two-way communications between aprescriber and a pharmacist, however.

U.S. Pat. No. 7,072,840, describes a prescription generation systemwhere patient-identifying data, prescribed drug identification data,drug quantification data, and other prescription information areentered, which are then used to create a prescription. The system doesnot provide for seamless, automated two-way communications between aprescriber and a pharmacist, and the system has no way of notifying aprescriber if a particular drug in a drug formulary is available at apharmacy or the price of the drug or the cost of the drug to the patientand/or the patient's insurance company.

SUMMARY OF THE INVENTION

An electronic prescription processing system is capable of two-wayelectronic communication between a physician and a pharmacy orpharmacist. The system may use a multi-path clearinghouse between thephysician's office practice management (OPM) system and a pharmacycomputer system. A physician may create electronic prescriptions usingan electronic signature. An interface is provided with a pharmacycomputer system such that an image of an electronic prescription andprescription information may be directly auto-populated into an entryscreen of a pharmacy computer system for checking and fulfillingprescriptions. In addition, the system processes communications betweenthe pharmacy and the physician's OPM system. A pharmacist may query thephysician's office, without any need to speak with the physician orstaff by telephone. Preferences may be entered into the processingsystem for messages internal to the processing system or fornotifications by email, text messages, instant messages and the like.The physician's office may respond to individual messages or may batchprocess a plurality of communications.

In one example, an electronic prescription processing system includes atleast one pharmacy system connected to a network capable of two-waydigital communications between a plurality of physician office practicemanagement systems and the at least one pharmacy system. The at leastone pharmacy system displays an image of the information entered as anelectronic prescription by a prescriber using one of the plurality ofphysician office practice management systems on a display and theinformation entered as an electronic prescription is auto-populated inentries for a prescription entry screen of the at least one pharmacysystem. In one example, a clearinghouse is electronically disposedbetween physicians' office practice management systems and computersystems for a plurality of pharmacies. One advantage of using aclearinghouse is that each pharmacy system may query, electronically,any of the prescribers, seamlessly and automatically, without speakingby telephone, to resolve questions about the electronic prescription. Amulti-path clearinghouse automatically correlates the query with ananswer from the prescriber, such as using a unique query identifier,when a prescriber of one of the plurality of physician office practicemanagement systems responds to the query from the at least one pharmacysystem.

In one example, a clearinghouse system correlates each of the querieswith each of the answers from the prescriber, when the office managementsystems responds to the pharmacy using a batch process for answering aplurality of queries from one or more pharmacies. A single electronictransmission from the office management system to the clearinghouse maybe used to communicate with a plurality of pharmacies, for example.

In one example, the clearinghouse provides access to information from adrug file database from one or more pharmacy systems. Then, a prescriberhas access to drug inventory and prices, immediately, and can discusswith the patient whether a lower cost alternative that ispharmacologically equivalent or acceptable as an alternative is desired,rather than a more expensive alternative. In another example, a lowercost pharmacy may be recommended within a reasonable distance from thepatient's preferred pharmacy. For example, the clearinghouse is capableof automatically providing notification to the prescriber of alternativeprescription items available at at least one pharmacy and thealternative pricing, and the clearinghouse allows the prescriber theopportunity to substitute an alternative prescription item oralternative pharmacy, electronically, in response to a query generatedby the prescriber's system for entry of an electronic prescription. Forexample, a clearinghouse system may notify the prescriber, or mayprovide to the prescriber's system for notifying of the prescriber,generic equivalents available at a pharmacy or an alternative pharmacy,together with pricing information, such as cost to the patient and/orthe patient's insurance company.

In one example, the clearinghouse automatically provides notification tothe prescriber of a recalled drug or information that a drug is notrecommended for the indications entered into the prescriber's practicemanagement system or electronic health record of the patient.Alternatively, a pharmacy system may provide such information to aphysician, either automatically or using an automated, two-waycommunication protocol between the pharmacist and the prescriber. Inaddition, a clearinghouse automatically may provide a suggestion of anacceptable alternative to the recalled drug or a drug not suitable fortreating a patient with the indications indicated in the patient'selectronic health records. The clearinghouse may provide the prescriberan opportunity to substitute the at least one acceptable alternative ofa recalled drug, electronically, in response to a query, for example.Alternatively, the query may originate from a pharmacy system uponreceipt of a prescription from the pharmacy system.

In one example, an electronic prescription processing system verifiesthe identity and authority of the prescriber to enter the electronicprescription using an electronic signature, biometric data, a passwordor a combination thereof. For example, the clearinghouse may be used toauthenticate the prescriber using an electronic signature. In anotherexample, a biometric data reader may be used to capture biometric dataof a prescriber, and the electronic prescription processing system, theclearinghouse or the pharmacy system uses the biometric data of theprescriber to authenticate a prescription or a change to a prescriptionauthorized by the prescriber. For example, after a prescription isauthenticated by the electronic prescription processing system, theinformation may be encrypted for transmission to a pharmacy system, suchas by a standard public key encryption system, which may be decrypted bythe clearinghouse and/or the pharmacy system using a private key, forexample.

In one example, an interface system may be coupled to a physician'soffice management system, such that the interface system couples theoffice management system to the clearinghouse and/or the pharmacies'systems, wherein two-way communications are established with theinterface system. The interface system is coupled to a data input andediting device and a display, for example. The data input and editingdevice may include a keyboard, a voice recognition system, a pointingdevice, a touch screen, a bar code reader, a scanner or a combinationthereof, for example.

In one example, an insurance formulary from an insurance company or agovernment insurer is maintained in a clearinghouse, a physician officepractice management system, an interface system, or a pharmacy system,and the system is capable of notifying the prescriber, automatically, ifa particular prescribed item is not included in the at least oneinsurance formulary. Then, the system may provide one or more acceptablesubstitutes for selection by the prescriber, for example.

In one example, the system includes a database, and all queries andanswers to the queries are stored in the database and are tracked, suchas within a database of a pharmacy system, for example. An alert may beprovided automatically to a prescriber, a pharmacist and/or theclearinghouse, if the prescriber and/or the pharmacist does not timelyreply to a query or response in the system, for example. Thus,unnecessary delays may be greatly reduced by managing the timeliness ofresponsed in the system. For example, the system may present an alert toa pharmacist responsible for processing the prescription, automatically,via the pharmacy system, after receipt of an answer from the prescriberto the query by the pharmacist or the pharmacy system.

A method of processing an electronic prescription uses the electronicprescription system to fill prescriptions after installing pharmacysystems and physician practice management systems and/or interfaces,which are each coupled to a clearinghouse, for example. The system iscapable of storing an image of a prescription together withauto-populated fields relating to the image of the prescription in adatabase, and transmits such information from physician office practicemanagement systems to the pharmacies, such as by using theclearinghouse. The pharmacies systems receive the information, which maybe stored in a pharmacy database, for processing and filling of aprescription. The information may be displayed on a display of apharmacist such that the pharmacist is capable of verifying theauto-populated fields of the information in the database against animage of the prescription, for example. A two-way communication protocolfor the pharmacist to electronically query a prescribing prescriberabout the prescription and for the prescribing prescriber to provide thepharmacy system with an answer to the query is provided by the system.Querying the prescribing prescriber and receipt of answers to the queryis seamless and automatic, providing the pharmacy system with the answerto its specific query, automatically notifying the pharmacist who madethe query, or another pharmacist, of the receipt of the answer from theprescribing prescriber.

According to one example, the method may automatically provide forverification and authentication of the prescriber and may be used forverifying that the prescription is ready to be filled. The system mayautomatically monitor the time elapsed between the time that the queryis made and receipt of an answer and may flag delays. For example, alevel of urgency may be increased if the answer is not received timely.For example, an elapsed time of two hours without receipt of an answermay prompt notification of the prescriber of a degree of urgency inanswering the query. In one example, the alert includes a visual alerton the physician office practice management system. The alert mayinclude sending an email, contacting a cellphone number or activating apager, for example. Preferably, the method of alerting should allow thephysician to respond, seamlessly and automatically, by selecting ananswer or by providing comments in a response, and the system will matchthe response to the respective query, providing an answer to thepharmacist. For example, an email flagged as urgent may provide aselection of yes/no for responding to the query, and wherein selectingyes or no from the selection provides a response to the query,transmitting the response to the pharmacist or another pharmacist.

One advantage of the electronic prescription system that it allows aphysician to use a drug file of an intended pharmacy such thatauto-population occurs when the pharmacy receives information from aphysician's office. This reduces transcription errors and eliminatestranscription costs.

An additional advantage is that once the physician determines whichpharmacy the patient uses, the physician may use the actual uploadeddrug file information from the selected pharmacy when choosing thepatient's medication. Yet another advantage is that the doctor andpatient may be informed about the cost of a prescribed medication to thepatient and may be provided with lower cost alternatives.

Another advantage is there is no need to have a pharmacy point of salecomputer because the electronic prescription system is capable of goingdirectly to and from the physician's practice management system and thepharmacy computer system. All of the normal checks and verifications,such as checking multiple prescriptions for a patient having knownadverse interactions may be checked on the pharmacy's computer system.Another advantage is that needless phone calls may be avoided, allowingthe pharmacist's question to be resolved, and allowing the prescriptionto be dispensed.

Another advantage is that failure of a physician to timely response,such as within two hours, to a query may flag a query as having anincreased urgency. Yet another advantage is that the system may alert aphysician of an urgent query, such as by an audible, vibrational, visualor other alarm.

Yet another advantage is that the electronic prescription system allowsfor a two-way communication between the physician and the pharmacist.Yet another advantage is that the need for technician support and thechances of a prescription error are reduced especially errors incommunication and transcription of prescriptions

Still another advantage is the electronic prescription system allowsphysician to enter necessary prescription information, reducing errorscaused by handwritten prescriptions. Another advantage is a securesystem using an electronic signature avoiding prescription fraud. Stillanother advantage is that an image of the electronic prescription may bedirectly displayed on the pharmacist computer screen along with theauto-populated information which is found on the prescription entryscreen.

An additional advantage is that the auto-population process isintegrated into the system and connects directly to the pharmacycomputer system, including access to drug files, listing all the drugswhich the specific pharmacy uses, including specified generics.Additionally, the drug file may be constantly updated including recallor advisory notices that the physician might not otherwise be aware of.Still another advantage is that the system identifies preferred drugswitches and sends such information to the physician for a possibleswitch before the physician even sends out an electronic prescription.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 depicts an example of an electronic prescription processingsystem process.

FIG. 2 shows another example.

FIG. 3 illustrates an example of an electronic prescription.

FIG. 4 shows an example of a known prescription process.

FIG. 5 shows an example of a pharmacy processing a prescription using anexample of an electronic prescription processing system.

FIG. 6 displays an example of a pharmacist computer screen.

DETAILED DESCRIPTION

The examples described and the drawings rendered are illustrative andare not to be read as limiting the scope of the invention as it isdefined by the appended claims. In the drawings, lines of communicationare shown by arrows that indicate direction. In each case, the same modeof communication may be used for sending and receiving electronicinformation or different modes may be used for such as internet, textmessage, instant message, dial-up access and the like, for sending orreceiving electronic information.

The term “physician” is not limited only to a medical doctor, as usedherein, but is used broadly to describe any prescriber of medications orother prescription items, such as prescription medical equipment,biologics and the like. The term physician may include a medical doctor,dentist, psychiatrist, surgeon, or the like. The term “physician'soffice” is intended to include a physician and staff or a physicianpractice and staff. The term “pharmacy” is intended to include apharmacist and staff or a pharmacy including at least one pharmacist andstaff.

In FIG. 1, a plurality of physician's offices may have a computer systemwhich has a type of software used to create prescriptions, billing,patient profiles, etc., which is referred to as an office practicemanagement (OPM) system. An OPM system is connected to the Internetanother system for effectively communication with the electronicprescription processing system.

In one example, as illustrated in FIG. 1, a plurality of OPM systems 100are electronically coupled to a clearinghouse 116, such as by a networksuch as the internet, for example OPM system 104 is integrated with anelectronic prescription processing system. The OPM system 104 may be athird party system licensed for use by the physician's office. Aconnection 112 electronically couples the OPM system 104 to aclearinghouse 116. Communication between the clearinghouse 116 and theOPM system 104 occurs via clearing house connection 128, for example.The same connection 112 that is used for coupling the OPM system 104 tothe clearing house 116 may be used for two-way communication between thephysician's office and the pharmacy, for example.

In one example, a physician purchases or licenses an OPM system 102 thathas an integrated electronic prescription processing system 120 of apharmacy, for example. Another connection 134, as shown in FIG. 1,couples a clearinghouse 116 to another OPM system 102, and a differentconnection 114 couples the same OPM system 102 to the clearinghouse 116.The electronic connection 114, 134 may be used for two-way communicationbetween the OPM system 102 and the clearinghouse 116, for example.

In another example, an existing physician practice management system106, which is not integrated with an electronic prescription processingsystem, uses an import/export interface with an interface system 108,which may be a stand alone terminal, a virtual machine, or anindependent process operating on the same computer system as the OPMsystem. An interface connection 110 couples the OPM system 106 with theinterface system 108, which may include two-way communication betweenthe OPM system 106 and the interface system 108. In one example, aphysician's office uses a stand alone terminal 108 to access theelectronic prescription system's clearinghouse 116 without the use ofany OPM system 106.

An interface system 108 may be coupled to a clearinghouse 116 byinterface connections 132, 144, which may use the same channel ofcommunication or different channels, provided that electronicinformation is passed without human intervention. Digital communicationof information and queries are sent electronically avoidingtranscription errors, for example. Electronic connection 144 couples theclearinghouse 116 to the interface system 108, using the internet, forexample. Alternatively, a single electronic connection may be used fortwo-way communication. The interface system may be coupled, directly orindirectly, to a data input and editing device and a display, such as avoice recognition system, a keyboard, a pointing device, a touch screen,a bar code reader, a scanner or a combination of these, for example.

A pharmacy connection 124 couples a pharmacy computer system 120 to theclearinghouse 116. Electronic communication between a multi-pathclearinghouse 116 and pharmacy computer system 120 occurs via electronicconnection 118, for example. In one example, a plurality of pharmaciesare coupled to a single clearinghouse 116. In one example, a pharmacy isselected by a patient and/or the physician's office according toavailability, price, location or other criteria.

Another pharmacy connection 126 couples a pharmacy computer system 120to a point of sale system 122 where prescriptions are entered ordispensed. In this example, an internal pharmacy connection 126 is shownas a single two-communication path 126 such as an intranet, an extranet,a wide area network or another private data network. Alternatively, twoor more electronic connections may be used, such as the internet orphone lines, power lines, transmitters/receivers, or the like.Information may be secured by encryption during transmissions.

Information, such as patient name, address, insurance information,physician information, and the like, may be entered into any system suchas those shown for the OPM systems and/or interface systems 100.Prescription in format may be entered by a point of care physician, forexample. In one example, a drug file from a pharmacy 120 is uploaded tothe clearinghouse 116 and is sent to the appropriate practice managementsystem that a point of care physician is using, such as an OPM system102, 104, 106 for example. When a physician's office chooses one or morepharmacies as preferred pharmacies, the physician may have access to thepharmacy drug files, including a list of drugs and generic drugsdispensed by each of the preferred pharmacies, and prices, for example.

Once a particular drug and a pharmacy is selected, then an electronicprescription (e-script) is created. For example, the e-script mayinclude an image 300, a physician electronic signature, biometric data,electronic information identifying the pharmacy, the specific drug ordrugs prescribed, patient insurance information, and the like. Thephysician may review and send the e-script using one of the systems to aclearinghouse 116. For example, the clearinghouse 116 forwards thee-script to the selected pharmacy computer system 120 that is selectedby the physician/patient.

The clearinghouse 116 is capable of uploading pharmacy drug files andpreferred medications on specific drug plans. The drug files provide theelectronic prescription processing system with the ability to notify thephysician of suitable alternatives that are included in the patient'sdrug plan or are available at a reduced cost to the patient, allowingthe physician and patient to interchange medications in the same drugcategory, for example. Once the electronic prescription has been routedto the correct pharmacy computer system, the prescription informationmay be auto-populated on an existing pharmacy prescription entry screenof the pharmacy computer. The auto-populated screen may contain all thefields used by the pharmacy to process a prescription including ane-script image so that the pharmacist could verify the populated fieldsagainst an image of the electronic prescription. Since the physicianuses the drug file with the same generics that the pharmacy has orutilizes a brand name drug that could be changed to a generic drug ifallowed by the physician, the prescription dispensing would continue asif a pharmacy technician imaged a prescription and entered theappropriate drug file information, without the chance of inadvertenttranscription errors, for example. For legal purposes, the electronicprescription with the electronic signature may be printed in thepharmacy and identifying marks (i.e., bar codes) may also be printed forfiling. In addition or alternatively, biometric data or an encryptedcode, entered by a prescribing physician, may be used to verify theauthenticity of the prescription. The electronic prescription system iscapable of uploading drug formulary of pharmacies and approved drugformulary of other third parties, such as managed care plans, insurancecompanies, Medicare and the like. Accordingly, the drug formulary may bepatient-specific, depending on which pharmacy and insurance company thepatient uses, for example.

If there are questions about the prescription or how the prescriptionaffects the patient, such as drug interaction, a particular prescriptionbeing filled too soon, duplicate therapy, managed care issues and otherissues, the physician may need to be contacted by the pharmacist. Thepharmacist may use the system to communicate directly with theprescribing physician, such as typing a question in a comment field 628,as shown in FIG. 6. Then, the information and question may be routedusing the system to the physician via the clearinghouse 116 or directly.The physician may resolve the issue and send back information to thepharmacy system 120 for review by the pharmacist. The pharmacy may fillthe prescription, which is delivered to the patient. In one example, apoint of sale system is notified of the status of a prescription on holdfor information from the physician. While transcription errors and humanerror are eliminated, surprisingly, costs are reduced, also, compared tothe known system of FIG. 4, for example. Costs that may be reducedinclude insurance costs, patient costs, costs of filling prescriptionsby pharmacies, malpractice insurance costs, and the like. In addition,prescription drug prices, may be reduced by increasing awareness ofsuitable alternatives and generic equivalents of more expensive drugs.

One advantage of the system is HIPAA compliance. The only sharing orexchange of patient identifying information is that required to fill theprescription. Communications between a pharmacist and a physician may besecurely encoded, for example. In addition, the pharmacist has theability to verify patient profile and send in questions to physician'soffice in order to safely dispense medications without undue delayscaused by telephone inquiries. This eliminates the need to call thephysician directly, which is a time consuming and costly process thatsubstantially delays filling a prescription. Furthermore, questions maybe queued up in a physician's computer, which may be accessed at anytime by the physician. Accordingly, the physician's office may answerquestions by pharmacists and return answers efficiently as a batchprocess using the system. In this way, delays in filling prescriptionsmay be reduced and costs of telephone inquiries eliminated, withoutinterrupting point of care services.

In one example, a communication from a pharmacy computer system 120 isrouted through a clearinghouse 116. Unlike known systems, the pharmacycommunicates back with the physician using the system. Because of thistwo way communication feature, communications are improved, costs arereduced and errors reduced. A clearinghouse 116 may upload informationabout medications, which may be used to notify physician/patient aboutdrugs available at a pharmacy from a pharmacy computer system and/orreimbursed by a specific insurance plans according to an insuranceformulary. The system may identify generic equivalents and may provide amechanism for switching to a preferred drug based on suitableindications, price, availability or a combination of these, for example.The clearinghouse 116 may identify these preferred drugs and may presentsuch information to the physician's office in a standardized electronicform for the physician and/or patient to consider as a betteralternative, such as a more suitable alternative for indications or aless costly alternative, for example. Such information may be queued onthe physician's office and accessed at the convenience of the physician.If the physician selects an alternative or prefers not to select analternative, such information may be transmitted to the pharmacy usingthe system. In one example, this all occurs as the physician ispreparing and reviewing the e-script, prior to transmitting the e-scriptto the pharmacy. In another example, the system automatically providesalternatives after the e-script is received by the clearinghouse butprior to receipt by the pharmacy. The physician may consider if thealternatives are acceptable and may confirm substitution of analternative prescription, easily. This eliminates phone calls and awasting of a pharmacist's time, and also has the potential of savingsubstantial health care costs. Alternatively, messages from and to thephysician/pharmacist may be queued up and accessed at a later time. Thisbatch processing improves convenience and has the potential ofincreasing efficiency. In one example, the pharmacy system mayautomatically provide suitable alternatives for selection by aphysician, based on lower cost, availability, or indications, forexample.

In FIG. 2, an example of a plurality of OPM systems 100 are illustrated,schematically. An integrated OPM system 102 is an example of a computersystem having a practice management system that has an electronicprescription processing system built into it. The integrated practicemanagement system 102 meets multiple office needs (i.e., billing,storing of patient information, appointment schedules, etc.). The vendorof the OPM system incorporates the electronic prescription processingsystem integrally with these other functions, providing an integratedsoftware package.

Another OPM system 104 is operable with an electronic prescriptionprocessing system, seamlessly, but the electronic prescriptionprocessing system operates as a separate program either accessing thesame database, such as an SQL database, or communicating information toan from the OPM system 104. Such a system 104 would license anelectronic prescription processing system utility that is installedtogether with the OPM system 104.

A pre-existing OPM system 106 may be an older system that is not capableof integrating or communicating with an electronic prescription systemdirectly, for example. Instead, the pre-existing OPM system maycommunicate 110 with an interface system 108. The interface system 108may capable of extracting data from the pre-existing OPM system 106 andtransferring e-script and other communications of the electronicprescription processing system to a pharmacy. Alternatively, theinterface system 108 may be used as a stand alone system.

In FIG. 3, one example of an image on electronic prescription 300 isschematically represented. For example, a name field 302 displays thename of the sender, such as a physician. Issue date field 304, forexample, is the location the issue date. Doctor information field 306,describes the doctor's name, address, DEA number, and fax number, forexample. Patient data field 308 describes the patient's name, address,date of birth, insurance company, insurance group, and insurance IDnumber, for example. Drug data field 310 illustrates the drug name andstrength. Drug amount field 318 shows the drug quantity to be dispensed.Prescribed usage field 312 provides instructions for the use of themedication. Refill data field 320 indicates refills. Signature field 314shows an electronic signature by the physician, which is accepted inmost states as a valid prescription. In addition, biometric data or apassword may be required to authenticate a valid prescription and toreduce counterfeit and fraudulent prescription. Substitutionauthorization fields 3I 6 and 322, respectively illustrate that thepharmacist may substitute or may not substitute an equivalent for theprescribed medication. Rx ID field 324 depicts the prescription ID mark.In one example, the Rx ID mark/field 324 includes a barcode.

In FIG. 4, an example of a conventional process is shown. Doctor'soffice 400 includes a database 402, and a practice management system404. Such a system transmits info to the pharmacy via steps 406 or 434.For example in step 406, the written prescription may be brought in bythe patient, or may be mailed, a facsimile may be transmitted of theimage of the scrip or otherwise transmitted. In another example, throughstep 434, information relating to prescriptions may be communicated to apharmacy by telephone, telephone network, fax or e-mail without an imageof the written scrip. Regardless, either method requires a human toenter the information into the pharmacy system, which is prone totranscription errors, and is time consuming, inefficient, and leavesopportunities for errors to occur.

The data entered from the prescription is transmitted 408 by thepharmacy system 110, which includes a pharmacy database 430. The actualwritten prescription is received 412 by the pharmacy and is then scanned414 by the scanning department creating image of the prescription in thecomputer system. The header entry department enters pertinentinformation such as physician's name, office information, patient name,insurance information and any other type of information to identify thepatient into the pharmacy computer 416, which may be recorded in thedatabase 430. The drug name, strength, quantity, refills, genericindication, brand indication, and directions are entered 418 by apharmacy technician.

The pharmacist verifies 420 and then dispenses 422 the prescription. Inthe verification process 420, the pharmacist may need to call the doctor428, conduct drug utilization review 426, or contact the managed caredepartment 424, if there is managed care issue. The pharmacy contacts432 the appropriate office or physician when there are issues about theprescription 428, a drug utilization issue 426, or managed care issue atstep 424, for example. In some cases, multiple calls may be necessary toget a complete answer to a question or questions.

When comparing this example with a system using an electronicprescription processing system of the present invention, manydifferences stand out. By eliminating certain steps a system thatprovides for direct two-way electronic communication and auto-populationof prescription information substantially reduces errors and timerequired of a pharmacist, the physician and their staff to resolveerrors or to request additional information.

Eliminating unnecessary, steps, such as scanning 414, data entry 416,418 and the like reduces costs and errors, for example. Using anauto-populated pharmacy entry screen of the prescription image, such asshown in the example of FIG. 6 allows a pharmacist to quickly verifyprescription information, including any alerts, recalls, adverse druginteractions and the like. A pharmacist may pull the information on thescreen, scroll down to see additional information about patientinformation, and verify or check the prescription, without theassistance of a technician that is normally required for data entry andreconciliation, reducing delays and eliminating pharmacy-side laborcosts.

Redundant steps, such as contacting 432, multiple offices or physiciansabout prescription errors 428, drug utilization 426 and/or managed careissues 424, may be eliminated. For example, automated, two-wayphysician-pharmacist communication eliminates any need to call 432. Thetwo-way system allows the pharmacist to enter questions in a pharmacistcomment field 628, as shown in FIG. 6, for example. Then, the question,alert or notification may be sent to the physician designated to respondin the electronic prescription. Any response from the physician isrouted to the e-script, may automatically alert the pharmacist and maybe reviewed by the pharmacist, which may be the same pharmacist oranother pharmacist working at the same pharmacy who may be designated inthe system.

In FIG. 5, one example of how a pharmacy processes an electronicprescription is schematically illustrated. Many large pharmacies have apharmacy computer system that is capable of connecting to all thepharmacy's locations. This may be a network, such as a cloud network, awide area network or the like. Each computer at a particular location ofthe pharmacy communicates with the pharmacy's computer system, which maybe a centralized server or mainframe in on example. A clearinghouse 116sends information to the pharmacy including an e-script. The e-script isdelivered 118 to the pharmacy's computer 120 and a pharmacist thenverifies the information. A hard copy of an image of the electronicprescription is printed and filed, if desired. One verified aprescription is released 126 to the point of sale location 122 fordispensing to a patient.

In one example, a pharmacy computer system of a chain of pharmacy pointof sale locations 122 stores all pharmacy data, electronically, in acentralized database 510. Each chain pharmacy and computer terminal ofthe chain of pharmacies may be connected to the pharmacy computer system120 and communications 126 occurs seamlessly. In one example, internalpharmacy communications 126 occur seamlessly with a mainframe, forexample. In an alternative example, a centralized server replaces themainframe, and all communications are seamless. In yet another example,the pharmacy computer system is a distributed system, and only thedatabase 510 is centralized. A centralized system may inform adistributed system of a newly released prescription ID, and thedistributed system accesses information from a centralized database 510.Herein, a centralized database 510 does not infer that all data isstored at a single location. Instead, it means that all distributedsystems have access to the same data, which, may be stored as a SQLdatabase at one or more storage locations.

Communication 124, 118 between a clearinghouse 116 and pharmacy computersystem 120 may provide for two-way communication, for example. A singleelectronic connection may be used for two-way communication or multiplemodes and pathways may exist to provide two-way communications 118, 124.

A pharmacy computer system 120 includes a database 510. Informationrelating to an electronic prescription is transmitted 126 to theindividual pharmacy locations 122. In one example, a local pharmacistverifies the information provided by the electronic prescription 504, ane-script may be printed 502, and the pharmacy dispenses medicationassociated with a verified e-script to the patient 506. The pharmacistmay opt to use a conventional process 508 of filling a prescription byforwarding 500 the prescription for processing according to FIG. 4, forexample. Two-way communication 126, electronically, between the pharmacyand the pharmacy system 120 and the clearing house 116 permits safe,secure queries between a pharmacist and the prescribing physician tooccur rapidly. Delivery and read status indicators can be used to trackprogress in resolving discrepancies with one or more offices and/orphysicians. Answers may alert the appropriate pharmacist to review theanswer and to take further actions as appropriate. All queries andanswers may be automatically logged to the pharmacy system database 510by the pharmacy system 120. Timeliness of responses to queries may betracked and an additional query may be transmitted or the urgency of aquery may be increased. In on example, a query may be flagged forimmediate response or may present an audible, vibrational or otheralert, when a response is not timely.

In FIG. 6, an example of a pharmacist computer screen 600 is shown. Thepharmacist entry screen 606 includes an image of the prescription on thescreen as well as an area to enter information from the image into thepharmacist computer. The system allows information from the physician tobe directly presented to the pharmacist. All fields may beauto-populated with information reducing entry and transcription errors.In one example, the pharmacist may edit information on the entry screen606. The pharmacist may hit a single key or button to release thee-script for filling. Then, a label may be printed, the label may beadhered to a bottle and/or attached to a bag and the correspondingmedication may be dispensed. This eliminates many of the steps shown inFIG. 4. Furthermore, communications between pharmacist and physician aregreatly enhanced and timeliness is measured and improved.

Prescription image viewer 602 allows visual verification between animage of the prescription 604 and the entry screen 606. In one example,the entry screen 606 includes physician information 608, patientinformation 610, insurance information 612, drug name 614, drug strength616, directions 618, quantity 620, days of supply 622, dosages per day624, refills 626 or any other information necessary for verifying andfilling the prescription. The pharmacist comment area 628, may be usedby the pharmacist to enter comments or questions for an office orphysician. For example, if a prescription needs to be sent back throughthe system to the prescribing physician for clarification of anyquestions or alert the physician about any other matter requiringphysician interaction, then a pharmacist may enter or select a specificquery question, alert or notification and may press a key or button (onscreen or otherwise), to transmit the question, alert or notification todesignated physician office or other responsible party. For example, thephysician or office may receive an alert by text message, email, instantmessage or the like. An alert may provide notification to the physicianto access the physician's OPM system, for example, or may provide a linkor access to a reply server. In one example, a clearinghouse 116 sends amessage allowing the physician to answer a yes/no question using a cellphone, mouse, pointing device or voice command, for example. Then, aresponse may be transmitted answering the posed question(s). Biometricdata, a password or an electronic signature may be required forauthenticating an answer.

In another example, the physician may not have entered a prescriptionand a pharmacy may enter a prescription subject to approval by thephysician. An e-script is may be transmitted to the doctor for his orher approval with questions or comments. Once the physician answers thequestions, which may be required prior to proceeding, the physician maysend the electronic prescription to the pharmacy for further processing.In one example, unique ID and/or password is required to updateinformation stored on a pharmacy computer system, for example.

In one example, the generation system disclosed by U.S. Pat. No.7,072,840, may be used to generate an e-script, for example.Alternatively, an e-script may be generated by a third party OPM system.A clearinghouse 116 may automatically require population of certainrequired fields necessary for verification of an e-script by apharmacist, for example. In one example, the e-script is automaticallyrejected by the clearinghouse 116 with a request for specificinformation to be entered into fields of an e-script. An interfaceprogram, capable of coupling to a MEPPS system, for example, mayauto-populate prescription information for a pharmacist entry screensuch as illustrated in FIG. 6. The system may further upload drugformulary of a specific pharmacy or pharmacies and insurance company orcompanies. For example, a formulary for a managed care plan may alert aphysician to availability of alternatives to a drug not included in theformulary or drugs that are less expensive. Thus, alternativeprescription items may be suggested or recommended for selection by thephysician.

Alternative combinations and variations of the examples provided willbecome apparent based on this disclosure. It is not possible to providespecific examples for all of the many possible combinations andvariations of the embodiments described, but such combinations andvariations may be claims that eventually issue.

What is claimed is:
 1. An electronic prescription processing system forat least one pharmacy system coupled to a network, the electronicprocessing system comprising: a clearinghouse coupled to the at leastone pharmacy system by the network for providing two-way digitalcommunications between the at least one pharmacy system and theclearinghouse, the clearinghouse connecting a plurality of physicianoffice practice management systems to the at least one pharmacy system;and the clearinghouse is electronically disposed between the pluralityof physician office practice management systems and the at least onepharmacy system, such that the electronic prescription is transmittedvia the clearinghouse from one of the plurality of physician officepractice management systems to the at least one pharmacy system; andwherein the clearinghouse includes a reply server, the reply servercomprising a two-way digital communications protocol for correlating aquery about the electronic prescription as submitted to theclearinghouse by the at least one pharmacy system and for sending amessage to the one of the plurality of physician office practicemanagement systems that transmitted the electronic prescription to theclearinghouse and for correlating the answer to the message from the oneof the plurality of physician office practice management systems withthe query by the at least one pharmacy system, without speaking bytelephone, such that the two-way digital communications protocol directsthe answer to the at least one pharmacy system that sent the query. 2.The electronic prescription processing system of claim 1, wherein, thereply server of the clearinghouse includes a batch processor forautomatically correlating a plurality of queries from one or more of theat least one pharmacy systems in a batch process using a singleelectronic transmission from the one of the plurality of physicianoffice management systems.
 3. The electronic prescription processingsystem of claim 1, wherein the clearinghouse includes an alternativedrug selection system for automatically providing one or morealternatives to a drug identified in an electronic prescription, whenthe electronic prescription is received by the clearinghouse from one ofthe plurality of physician practice management systems; and thealternative drug selection system provides the one or more alternativesto the physician office practice management system for selection by theprescriber on a display of the physician office practice managementsystem before the clearinghouse submits the electronic prescription tothe at least one pharmacy.
 4. The electronic prescription processingsystem of claim 1, wherein the clearinghouse includes a verificationsystem for verifying the identity and authority of the prescriber toenter the electronic prescription using an electronic signature,biometric data, a password or a combination thereof.
 5. The electronicprescription processing system of claim 4, wherein the verificationsystem of the clearinghouse verifies the identity and authority of theprescriber to enter the electronic prescription using an electronicsignature.
 6. The electronic prescription processing system of claim 1,wherein clearinghouse correlates a single transmission from a prescriberoperating in a batch mode to a plurality of queries from one or more ofthe at least one pharmacy systems.
 7. The electronic prescriptionprocessing system of claim 1, further comprising a biometric datareader, wherein the biometric data reader captures biometric data of aprescriber, and the electronic prescription processing system uses thebiometric data of the prescriber to authenticate a prescription or achange to a prescription authorized by the prescriber.
 8. The electronicprescription processing system of claim 1, further comprising aninterface system coupled to at least one of the plurality of physicianoffice practice management systems such that the interface systemcouples the at least one of the plurality of physician office practicemanagement systems to the clearinghouse, wherein two-way digitalcommunications are established between the interface system and theclearinghouse.
 9. The electronic prescription processing system of claim1, wherein the clearinghouse comprises a notification system arranged toprovide a notification of an alternative pharmacy to the one of theplurality of physician office practice management systems, if a drug orat least one acceptable alternative drug is not available from the atleast one pharmacy system originally selected, but is available from thealternative pharmacy or if the drug or the at least one alternative drugis available at lower cost to the patient or the insurance plan at thealternative pharmacy, presenting the one of the plurality of physicianoffice practice management systems an option for selecting thealternative pharmacy, before transmitting the prescription to the one ofthe at least one pharmacy systems originally selected by the one of theplurality of physician office practice management systems.
 10. Theelectronic prescription processing system of claim 1, wherein theclearinghouse includes a timer and the timer triggers if the one of theplurality of physician office practice management systems does nottimely reply to the query.
 11. A method of processing an electronicprescription using an electronic prescription processing systemcomprising a clearinghouse coupled to the at least one pharmacy systemby the network for providing two-way digital communications between theat least one pharmacy system and the clearinghouse, the clearinghouseconnecting a plurality of physician office practice management systemsto the at least one pharmacy system; and the clearinghouse iselectronically disposed between the plurality of physician officepractice management systems and the at least one pharmacy system, suchthat the electronic prescription is transmitted via the clearinghousefrom one of the plurality of physician office practice managementsystems to the at least one pharmacy system; and wherein theclearinghouse includes a reply server, the reply server comprising atwo-way digital communications protocol for correlating a query aboutthe electronic prescription as submitted to the clearinghouse by the atleast one pharmacy system and for sending a message to the one of theplurality of physician office practice management systems thattransmitted the electronic prescription to the clearinghouse and forcorrelating the answer to the message from the one of the plurality ofphysician office practice management systems with the query by the atleast one pharmacy system, without speaking by telephone, such that thetwo-way digital communications protocol directs the answer to the atleast one pharmacy system that sent the query, the method comprising:disposing, electronically, the clearinghouse between the plurality ofphysician office practice management systems and the at least onepharmacy system; transmitting the electronic prescription via theclearinghouse from one of the plurality of physician office practicemanagement systems to the at least one pharmacy system; coupling the atleast one pharmacy system to the clearinghouse, such that the image ofthe prescription is received via the clearinghouse by the at least onepharmacy system together with auto-populated fields relating to theimage of the prescription, such that the pharmacist is capable ofverifying the auto-populated fields of the prescription; and including areply server at the clearinghouse for correlating a query about theelectronic prescription as submitted to the clearinghouse by the atleast one pharmacy system, wherein correlating by the clearinghousecomprises the following steps: receiving the query at the reply serveras submitted to the clearinghouse by the at least one pharmacy system;sending a message to the one of the plurality of physician officepractice management systems from which the electronic prescription wastransmitted in the step of transmitting; correlating, at theclearinghouse, the query about the electronic prescription as submittedto the clearinghouse by the at least one pharmacy system and the answerto the query sent by the one of the plurality of physician practicemanagement systems, without speaking by telephone, providing two-waydigital communications using a two-way communication protocol for thepharmacist to electronically send the query to the clearinghouse aboutthe prescription and for the at least one pharmacy system to receivefrom the reply server of the clearinghouse the answer to the queryelectronically sent by the one of the plurality of physician practicemanagement systems, whereby the pharmacist or another pharmacist isnotified of the receipt of the answer from the one of the plurality ofphysician practice management systems.
 12. The method of processing anelectronic prescription of claim 11, further comprising: monitoring thetime elapsed between the time that the query is made in the step ofquerying and receipt of the answer, if any; and flagging the query ashaving a higher urgency if the answer is not timely received.
 13. Themethod of processing an electronic prescription of claim 12, wherein thestep of flagging occurs if two hours is elapsed from the time that thequery is made in the step of querying without receipt of the answer. 14.The method of processing an electronic prescription of claim 12, furthercomprising: alerting, automatically, a prescribing prescriber of thequery if the query is flagged as urgent.
 15. The method of processing anelectronic prescription of claim 14, wherein the step of alertingincludes an email sent by the clearinghouse to the prescribingprescriber, wherein the email is flagged as urgent.
 16. The method ofprocessing an electronic prescription of claim 15, wherein the emailflagged as urgent provides a selection of yes/no for responding to thequery, and wherein selecting yes or no from the selection of the emailsent by the clearinghouse automatically transmits a response from thereply server of the clearinghouse to the at least one pharmacy systemvia the two-way digital communications provided by the reply server ofthe clearinghouse.